Litigation Project Analyst, Sr

Position Summary

The Litigation Project Analyst, Sr provides expertise data support to projects related to confidential client information in claims litigation in accordance with company policy, regulatory requirements, and client needs.

"Has minimum necessary access to Protected Health Information (PHI) and Personally Identifiable Information (PII) by Job Description/Role."
Key Duties and Responsibilities


* Acts as lead project resource to stakeholders including attorneys, client, management, and auditors.


* Manages routine and complex audits of claims to ensure payment integrity in accordance with regulatory standards, plan benefit guidelines, and company policy.


* Reviews system processing of claims to ensure coding and system configuration are aligned with contract specifications.

Identifies noncompliant processes or outcomes and determines appropriate steps for resolution.


* Completes and maintains detailed claim documentation for all assigned projects to include decision methodology, system or processing errors, and monetary discrepancies.

Prepares reports of information for presentation to client and attorneys.



* Partners with management, Legal, and client to interpret plan, ACS, CMS, and other regulatory guidelines.

Creates, implements, and monitors processes in accordance with appropriate regulatory guidelines.


* Provides insight at case team meetings to ensure project participants are informed and aware of the objectives and requirements of a project.


* Recognizes and resolves technical issues identified during special project work and assigns resolution to appropriate staff.


* Interprets discovery data specifications and provides feasibility feedback to team and makes recommendations to management for changes or improvements to be implemented.


* Performs other related duties as assigned.

Minimum Qualifications


* High school diploma or GED.


* Four years of experience working on the Special Projects Team.


* Demonstrated proficiency of plan guidelines and claims adjudication process.


* Proficiency with MS Office tools and applications.

Preferred Qualifications


* College degree in Mathematics, Statistics, or similar discipline.


* Certifications in SQL, R, VBA, or Python.



*Please note this job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee of this job.

Duties, responsibilities and activities may change at any time with or without notice.

Zenith American Solutions

Real People.

Real Solutions.

National Reach.

Local Expertise.

We are currently looking for a dedicated, energetic employee with the necessary skills, initiative, and personality, along with the desire to get the most out of their working life, to help us be our best every day.

Zenith American Solutions is the largest independent Third Party Administrator in the United States and currently operate...